LEAVE OF ABSENCE FORM LEAVE OF ABSENCE FORM

(Form HRAD004-11/05/15) (Form HRAD004-11/05/15)

DATE NAME DATE NAME

DESIGNATION DEPARTMENT BRANCH / LOCATION DESIGNATION DEPARTMENT BRANCH / LOCATION

TYPE OF LEAVE / Charge to: TYPE OF LEAVE / Charge to:

VL Credit TOTAL NO. OF DAYS: ___________ VL Credit TOTAL NO. OF DAYS: ___________
From: ______________________ From: ______________________
SL Credit Day Off: ______________________ SL Credit Day Off: ______________________
Emergency Leave To: ______________________ Emergency Leave To: ______________________
Authorized Absence Authorized Absence
Maternity / Paternity Maternity / Paternity
Others: Others:
REASON/S: REASON/S:

Requested by: Approved by: Requested by: Approved by:

__________________________ _____________________ __________________________ _____________________

Employee Department Head Employee Department Head
Signature - Date Signature - Date Signature - Date Signature - Date
NOTICE TO EMPLOYEE NOTICE TO EMPLOYEE
Absences due to sickness for 2 days or more must be supported by a MEDICAL Absences due to sickness for 2 days or more must be supported by a MEDICAL
CERTIFICATE. CERTIFICATE.
Recorded by: Recorded by:
HR DEPARTMENT USE _____________________ HR DEPARTMENT USE _____________________
VL SL HRAD Assistant VL SL HRAD Assistant
Available Leave Signature - Date Available Leave Signature - Date
Less: Request Checked by: Less: Request Checked by:
Balance _____________________ Balance _____________________
Without Pay HRAD Head Without Pay HRAD Head
Signature - Date Signature - Date
Distribution: Copy 1- Employee Copy 2- HR & Ad Distribution: Copy 1- Employee Copy 2- HR & Ad